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My Lords, my interest in this Bill was drawn by my concern to stop more avoidable deaths of sufferers of eating disorders—sufferers such as Averil Hart, who died aged 19 and whose death, and that of two other women sufferers, was investigated by the Parliamentary and Health Service Ombudsman. The title of the ombudsman’s 2017 report says it all: Ignoring the Alarms: How NHS Eating Disorder Services are Failing Patients. It concluded:
“Our investigation found that Averil’s tragic death would have been avoided if the NHS had cared for her appropriately”,
and it went on to make five recommendations for improvements in NHS eating disorder services.
Eighteen months later, in June this year, the Public Administration and Constitutional Affairs Committee in the House of Commons followed up on that PHSO report and concluded that insufficient progress had been made on delivering its recommendations. I echo the comments of the chairman of the PACAC, Sir Bernard Jenkin MP, who said that,
“if the tragic circumstances which lead to avoidable in-care deaths and other serious incidents are to be avoided in the future, lessons must be learned”.
Moreover, the PHSO acknowledges many examples in its casework where poor investigations or fear of blame have hampered efforts to understand what went wrong in a patient safety incident and what can be done to prevent similar failings happening again. Therefore, like others, I welcome this Bill, given that investigations by this new independent body that do not attribute blame but ensure a statutory “safe space” for NHS clinicians, patients and their families to speak freely will be a key part of enabling such learning.
I have three issues to raise with the Minister, some aspects of which have been touched upon by other colleagues around the House. First, while helping the NHS to learn lessons is critical, so is supporting the patients and families involved, giving them confidence in the investigation process and thus the recommendations. That way, hopefully, they can move on with their lives or feel that something positive has come from the death of a loved one. Public confidence in the membership of the board is therefore key. As it stands—as the noble Lord, Lord Hunt of Kings Heath, has said—the Secretary of State appoints the chair and at least four other non-executive members of the body. I have the highest regard for the medical profession, and looking around this room I see many experts, but I would be concerned if all the members were from the medical profession or, indeed, were associated too closely with the party in power; let us not forget that this body has the power to make recommendations for the Secretary of State to implement. I therefore add my voice to those of the noble Lord, Lord Hunt of Kings Heath, and my noble friend Lady Walmsley, who asked what plans the Government have to achieve an appropriate level of independence for the body so that it can instil the highest public confidence.
The second issue is ensuring that lasting change happens. As we know, the HSSIB has the power to make recommendations for future action after an investigation, and addressees of the report must, by the deadline given, provide a written response setting out the action they will take in relation to the recommendations. That is welcome but, given the failure to implement recommendations in the PHSO report that I mentioned on eating disorder services, I worry. My understanding is that NHSE and NHS Improvement will be charged with monitoring the follow-up; I would be grateful if the Minister could confirm that in her concluding remarks. However, it would also be helpful if the HSSIB had the power to insist on follow-up reports on the actions and outcomes, to ensure that meaningful and lasting improvements to patient safety will be made.
The final issue concerns the relationship of the new body to other bodies which not only focus on the causes of incidents but provide accountability for individual incidents and, if necessary, apportion blame. This issue has been touched on by the noble Lords, Lord Hunt and Lord O’Shaughnessy, and the right reverend Prelate the Bishop of London, although I think we will all come to different conclusions.
I have talked about the valuable work of the PHSO, which was set up by Parliament to provide an independent service to handle complaints about the NHS in England, UK government departments and other UK public organisations. It is the final stage for complaints that have not been resolved through the organisation’s own complaints procedures. In the case of Averil Hart, Averil’s father Nic Hart went to the PHSO after making complaints to six organisations: four separate NHS organisations which had provided care and treatment for Averil, as well as a local clinical commissioning group and NHS England. The PHSO is the last resort for the public yet, as the Bill stands, it cannot have access to information held in a safe space by HSSIB, to carry out its own investigations into the complaints that it receives. This could lead to the ombudsman making incomplete or incorrect recommendations for either individual or systemic remedy.
I accept the value of the HSSIB carrying out investigations in a safe space to promote a culture of speaking up and learning from mistakes, but this cannot be the only aim when looking at why incidents in the NHS went wrong. If the PHSO cannot provide assurance that it is able to investigate all the relevant evidence, this could deny patients or families closure and reduce public confidence in the findings of the organisation. The PHSO has a statutory obligation to investigate in private and is protected from disclosure under the Freedom of Information Act, so there is strong assurance that any information given would not enter the public domain. Further, given the parallels between its work and that of coroners—who have been given exemption from restrictions on receiving information from this new body—and in the absence of compelling reasons from the Minister, I would support an amendment to this Bill to provide the PHSO with access to HSSIB information. We need both bodies to be able to do their jobs properly—yes, to deliver change in the NHS but also to give confidence to patients and families that the suffering and loss that they and their loved ones went through will not keep being repeated.